ACLS Medications

Roy Smith

Oxygen
Uses
Increase supply of oxygen HYPOXIC EVENT Airway / BVM NR Simple mask Cannula

Dose

Nitroglycerine
Uses
Vasodilatation AMI, CP, CHF Metered dose 0.4 mg SL 5 mcg/min increase every 5-10 min until desired clinical response Viagra within 24 hrs Rt Ventricular Infarctions

Dose

Relative contraindications

Morphine
Uses
Decreases myocardial oxygen consumption AMI,CHF

Dose
2-10 mg IVP

Naloxone
Mechanism of action
Competitive opioid antagonist

Uses
Opioid antagonism MS OD

Dose
0.4 2.0 mg

Aspirin
Uses
Stops platelet aggregation, Asprin blocks secretion of thromboxane A2 from the platelets, there by inhibiting platelet agregation.

Dose
162 - 325 mg oral

Medications to manage cardiac dysrhythmias

Adenosine Amidarone Atropine Betablockers
Atenolol Esmolol Labetalol Metoprolol propranolol

Calcium channel blockers

Verapamil Diltiazem

Medications to manage cardiac dysrhythmias cont.

Digitalis Disopyramide Epinepherine Isoproterenol

Medications to manage cardiac dysrhythmias cont.

Lidocaine Magnesium Procainamide sotalol

Adenosine
Mechanism of action
Found naturally in all body cells Slows sinus rate, slows conduction through the AV Node.

Uses
SVT, PERSISTENT PSVT

Dose
6,12,12 mg RIVP

Amiodarone
Mechanism of action
BLOCKS- sodium, potassium, sympathetic, and calcium channels

Uses
VT VF WCT

Dose
300 mg VT with pulse 150 mg x 2

Atropine
Mechanism of action
Parasympatholytic

Uses
bradycardias

Dose
0.5 1.0 mg 0.04 mg/kg max dose

Beta Blockers Lopressor

Mechanism of action Uses
Blocks beta receptors decreasing contractile force of the heart. Reduces BP, Reduces incidence of dysrrythmias, Reduces risk of sudden death. 2.5-5 mg q 2-5 min up to 15 mg

Dose

Calcium Channel Blockers Cardizem

Mechanism of action Uses
Blocks calcium channels reducing contractile forse and conduction through AV node Atrial tachycardias A-fib, a-flutter Cardizem

Dose

0.25 g/kg

Digoxin
Mechanism of action
Suppresses SA node, prolongs AV conduction, positive inotrope, incr peripheral resistance via inhibition of Na/K-ATPase making more Ca available to actin & myosin Reduces conduction through the AV node. 0.4-0.6 mg IV x1

Uses

Dose

Epinepherine
Mechanism of action
Stimulates both alpha and beta receptors, increases chronotropic, iontropic effects. Increased contraction, rate, and vascular resistance.

Uses

Pulseless cardiac arrest Pea, asystole, vfib, vtach

Dose
1 mg IVP 3-5 min

Lidocaine
Mechanism of action Uses
Blocks sodium channels, decreasing myocardial contraction Raises VF threshold antiarrythmic 1-1.5 mg/kg IVP 3 mg/kg max

Dose

Magnesium Sulfate
Mechanism of action
Smooth muscle relaxant, reduces calcium action in action potential.

Uses
Torsades

Dose
1-2 G over 1-2 minutes

Procainamide
Mechanism of action
Decreases conduction velocity in the atria, ventricles, and His- Purkinje system, significant portion metabolized by acetylprocainamide having significant antiarrythmic activity.

Uses
Stable SVT, A-Fib, A-Flutter, WPW, WCT, VT,VF

Dose
20-30 mg/min

Medications used to improve cardiac output and blood pressure

Dopamine Norepinepherine Dobutamine Vasopressin Calcium chloride Sodium nitroprusside

Dopamine
Mechanism of action
Immediate precursor of norepinephrine in the body.

Uses
Cardiogenic shock

Dose
2-20 mcg/kg/min

Norepinepherine
Mechanism of action
Perpherial vasoconstrictor, coronary artery dilator.

Uses
Cardiogenic shock

Dose
8-12 mcg/min

Dobutamine
Mechanism of action
Stimulate alpha1, beta 1, and beta2, positive inotrope.

Uses
Cardiogenic shock due to chf, pulmonary congestion.

Dose
2-20 mcg/kg/min

Vasopressin
Mechanism of action
Antidiuretic hormone Binds to specific receptors vasporessin receptors, V1(V1a, V1b),V2 Vasopressin exerts a greater vasoconstrictive effect than api, causes a greater artery tonevasopressin does not increase myocardium oxygen consumption, or excessive lactate production.

Uses
Alternative to EPI in VT/VF

Dose
40 units 1 time.

Calcium chloride
Mechanism of action
Provides more calcium ion for an increase in contractile force.

Uses
Hyperkalemia, hypocalcemia, calcium channel blocker toxicity, magnesium toxicity, betablocker toxicity

500-1000 mg IV over 5-10 minutes

Other medications
Sodium bicarbonate Furosemide

Sodium Bicarbonate
Mechanism of action
Increases plasma bicarbonate, buffers hydrogen.

Uses
Hyperkalemia, acidosis, tricyclic, antidepressant OD, hypercarbic lactic acidosis.

Dose
1 meq/kg

Furosemide
Mechanism of action
Inhibits reabsorption of sodium in the loop of henly,

Uses
Loop diuretic

Dose
1 mg/kg 80 max